]]>As the UK summer starts to fade, many of our midwifery students are either beginning their studies or moving up a year. That means it’s time to update my post for students!

Hello, my name is Sara

I run a website, blog and heart-funded birth information project which can help those of you who are studying midwifery or birth-related areas. And it doesn’t matter whether you’re an aspiring or current student, or a birth worker who just wants to stay updated.

I’ve been a midwife (mostly independent, but not exclusively) for more than twenty-five years. I have worked in midwifery education and research. I’ve been invited to speak all over the world, I have written (or edited) sixteen books and I have been the editor of three midwifery journals. My goal is to help those who help women, babies and families. And here are ten ways in which you can use my work to help you in yours.

1. The Search Box

My website contains more than 500 articles, blog posts and information pages. You might find it useful to bookmark this site and use the search box when you’re looking for information. It’s in the top right hand corner of every page on my site.

2. Articles and Books

I’ve written lots of articles over the years! About ninety per cent of them can be found on my articles page. If you’re looking for an article that isn’t there, then the chances are that either I don’t have permission to post it, or I consider it too out-of-date to keep on here. If the latter is the case, I may have written something more recent, so it’s worth doing a search. When you need more depth, I have written books on all sorts of practice-related topics that you’ll need to know about. They include Inducing Labour, Group B Strep Explained, Vitamin K and the Newborn and Birthing Your Placenta. Many students and aspiring students have also found What’s Right For Me? making decisions in pregnancy and childbirth really useful. It explains issues relating to decision-making as well as being a good overview of the different belief systems that exist within maternity care.

3. My love letter to student midwives

One of the most popular blog posts on this website was written for student midwives. I don’t have time to answer every individual email that I receive, but I wanted to find a way to respond to lovely students who needed kind words. You might like to save it for when you’re not having a great day. Here it is: Eight things I’d like to share with midwifery students who care

6. Tons of dissertation tips (well, at least 101!)

If you ever feel uncertain about how you’re supposed to get going with academic work, or wonder how you can get better at fitting it all in, then I’ve written a book just for you! It’s called ‘101 tips for planning, writing and surviving your dissertation‘. It’s not just for your dissertation though, and you don’t need to wait! Many people get it in their first or second year or even before they begin their studies. That’s because a lot of the tips can be used for other assignments too. And it’s not midwifery-specific, so it works for people studying other subjects as well. If you’d like to read some of the tips to get a flavour of the book, check out this page which tells you all about it.

8. Tips for finding articles

I once wrote a post in response to people who were feeling frustrated when they couldn’t access articles. It’s very popular! If you’re at a university or school which offers you library access, you might not need this. But if you get stuck, or for those who aren’t as blessed in the reference department, here are Nine tips for accessing academic papers online.

9. Fabulous educational opportunities

I know that students’ financial situations vary widely and some aren’t able to do lots of extra-curricular stuff. But if you’re able to invest in your education, then I’d like to think that I offer some pretty cool opportunities. These include engaging online courses where you can connect with me and other midwives and birth folk from around the world. (All from the comfort of your computer, tablet or phone!). I also offer in-person conferences, talks and workshops. We always give my newsletter folks an early heads-up of my own courses. That’s because some of them sell out really quickly once they go onto social media. So if you’d like to get those free newsletters and updates and haven’t yet signed up, here’s the page that you need.

The results were clear. Let’s look first at physiological oxytocin levels.

“Basal levels of oxytocin increased 3–4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum.” (Uvnäs-Moberg et al 2019).

What is new, and a bit surprising, is that the researchers found, “no temporal connection between uterine contractions and oxytocin peaks, even when sampling was very frequent.” (Uvnäs-Moberg et al 2019).

The researchers speculated that this was because of the involvement of the parasympathetic nervous system, which is activated when oxytocin reaches the woman’s brain during physiological labour. As many will know, oxytocin enhances wellbeing, reduces stress and anxiety and has many beneficial effects relating to pain relief, mother-baby interaction and other aspects of birth.

Does nature know best?

These effects are only experienced when the oxytocin is produced by the mother herself though. Although the researchers found that, “Infusion of synthetic oxytocin at a rate of 4–9 mU/minute gives rise to oxytocin levels equivalent to levels during physiological labour,” (Uvnäs-Moberg et al 2019), there is a catch. Synthetic oxytocin, which is given to induce or speed up labour, does not reach the brain. Thus it does not have the same beneficial effects on the body as a woman’s own oxytocin.

The researchers also note that synthetic oxytocin is often increased to much higher levels than 9mU/minute. They include a useful discussion on why the use of synthetic oxytocin can be problematic and suggest ways in which this could be addressed. One of these is to look at whether synthetic oxytocin could be given in a “pulsatile” fashion. This would still, however, not address the fact that synthetic oxytocin does not reach the brain and help confer the many short and long-term advantages that are gained when the body makes its own oxytocin.

There is lots more in this paper about the relationship of oxytocin to the various stages of labour, and to uterine contractions. It is freely available online and I highly recommend reading it.

]]>https://www.sarawickham.com/research-updates/oxytocin-and-birth-the-latest-evidence/feed/041117Holiday time, and another self-care reminder :)https://www.sarawickham.com/announcements/holiday-time-and-a-self-care-reminder/
https://www.sarawickham.com/announcements/holiday-time-and-a-self-care-reminder/#respondThu, 29 Aug 2019 05:30:40 +0000http://www.sarawickham.com/?p=26420We're taking a short break for some travel and self-care!

]]>Every so often, the Director of Tea/Cake/Tech and I decide that we need a proper break, and we like to switch off completely. And, as you might know, we are big fans of proper self-care – not just the kind in which taking a wee break is deemed a treat in and of itself. We like to remind others about the importance of this as well.

So we are hereby going to switch off everything and leave the laptops at home. We’re not going to blog or reply to emails, messages or comments for the next week or two. It’s possible that we’ll post a photo or two on instagram if we feel like it. Or we may not even turn on our phones!

When we do get back, we’ll be working on some exciting autumn (spring down under) projects. And we’re very much looking forward to telling you about those.

Thank you for understanding. As usual, here are a few links to keep you going in the hope that this will inspire your own switch off and self-care

If you’re looking for birth information then I warmly invite you to surf around my site. If you’re looking for something specific, try typing key words into the search box. (You’ll find it in the top right hand side of every page). If you’d like sharable birth information, come and hang out with me on Instagram. And if you’re a midwife, doctor, doula, childbirth educator or other birth worker and you’d like a regular, reliable update on birth-related research and thinking, we can help with that too! Just tell us your email address and we’ll send you an email to your inbox every month, as well as advance notice of all my courses, workshops and new book releases

]]>https://www.sarawickham.com/announcements/holiday-time-and-a-self-care-reminder/feed/026420The induction crisis continues (and what we can do about it)https://www.sarawickham.com/riffing-ranting-and-raving/misinformation-about-induction-of-labour/
https://www.sarawickham.com/riffing-ranting-and-raving/misinformation-about-induction-of-labour/#respondThu, 22 Aug 2019 05:30:16 +0000https://www.sarawickham.com/?p=41025Connect with Sara Wickham to get resources to challenge induction misinformation.

]]>It might be the summer holidays here in the UK, but that’s not stopping the media from sharing misinformation about induction of labour.

From misquoted statistics to scary ‘spin’, we seem to be swamped with unhelpful information. We have read more comments than ever before from people who are concerned about this.

I think we need to be able to respond to this kind of thing with better information. And not because I want to persuade women to go down a particular path. Everybody deserves to have good information about all the options so that they can make the decision that’s right for them.

Can I help you?

We have responded to the increase in induction misinformation by increasing the number of information resources that we are putting out on this topic.

Instagram is a good way to share these. If you don’t already follow me on there, come on over and join me. I’m @drsarawickham and you’re welcome to share and repost my pics to help spread the word. (Always make sure you leave the original author credit. That way, others can find a creator’s website and resources too).

I’m also blogging about the issues, with more of that to come soon.

And we have lots of people signing up for the penultimate run of Gathering in the Knowledge 2019 (September 20-27). I have created a whole section in there on induction of labour, among many other hot topics. It contains a video lecture in which you can watch me critiquing the ARRIVE Trial, as well as discussions of other research, podcasts, written activities and chatting spaces. Come and connect with others as we analyse relevant studies which will help you get up-to-date and increase your understanding of the research! My aim is that you’ll leave knowing that you can respond more confidently in conversations with clients and colleagues.

]]>https://www.sarawickham.com/riffing-ranting-and-raving/misinformation-about-induction-of-labour/feed/041025Vitamin K Resourceshttps://www.sarawickham.com/topic-resources/a-decade-of-vitamin-k-articles/
https://www.sarawickham.com/topic-resources/a-decade-of-vitamin-k-articles/#commentsMon, 19 Aug 2019 05:30:36 +0000http://sarawickham.com/?p=317This post is a collection of links to articles and resources that I have authored on the subject of vitamin K and I have now updated it to reflect the publication of the second edition of my book – which…

]]>This post is a collection of links to articles and resources that I have authored on the subject of vitamin K and I have now updated it to reflect the publication of the second edition of my book – which I am delighted to tell you is now officially a bestseller – Vitamin K and the Newborn – and my most recent blog posts on this topic.

The first article that I wrote about vitamin K was published in 2001 and was called Vitamin K: a flaw in the blueprint?, where the title reflected the ideological and practical question that most interested me at the time; that of whether nature had really ‘got it wrong’. This article generated some really interesting discussion with a lovely paediatrician named Edmund Hey, who is sadly no longer with us. I have discussed some of his work in my book, Vitamin K and the Newborn.

I continue to be interested in the ideological questions that we were raising at that time, especially as vitamin K really does seem to be the proverbial sledgehammer to crack a nut. Several thousand babies need to be given vitamin K in order to prevent each case of vitamin K deficiency bleeding (or VKDB; a disorder formerly known as haemorrhagic disease of the newborn). Unfortunately, there is little research interest (as is so often the case) in questions such as (1) how we might be able to pick out the babies who are truly at risk rather than giving it as universal prophylaxis and (2) whether and why it might benefit babies to have a relatively low level of vitamin K compared to adults.

]]>https://www.sarawickham.com/topic-resources/a-decade-of-vitamin-k-articles/feed/1317Fixed point due date or a wider window (part 2)…https://www.sarawickham.com/topic-resources/fixed-point-due-dates-and-wider-windows-part-2/
https://www.sarawickham.com/topic-resources/fixed-point-due-dates-and-wider-windows-part-2/#commentsThu, 15 Aug 2019 05:30:27 +0000http://sarawickham.com/?p=903How do holistic midwives get across the fact that 'normality is a range' when talking about the expected date of birth, asks Sara Wickham.

]]>What are the downsides of our focus on having a due date? In my last post, I wrote about the problem of fixed point expectation syndrome. I suggested that the act of calculating and then focusing on an estimated due date is problematic. It is problematic because this one date becomes a much-anticipated fixed point. When it then passes before the arrival of a baby, as it inevitably will for a good proportion of women, the expectations that have been built around this can lead to difficult feelings, decisions and/or situations.

It would be unrealistic, however, to suggest the eradication of the fixed point due date. (I am, however, still very much open to my trip in the TARDIS to visit any universe where this notion has never occurred to anyone). Instead, I propose that, alongside whatever we do right now, we open discussions about wider windows with women, families, colleagues and everybody else. This problem is not limited to the confines of the antenatal clinic. Discussion of due dates permeates every corner of modern society.

Normality has a range

The notion of substituting a wider range of probable birthing time for the current fixed point due date isn’t new. In a classic article, midwife Brenda van der Kooy (1994: 5) noted that, “as elsewhere in nature, normality has a range”. Stickler (1994: 325) also recommended using “less specific terminology such as ‘month of expected delivery’ … [which] would cure the many ills stemming from the pseudoaccuracy of the EDC”. Until I began carrying out research into this, however, I hadn’t found any studies which demonstrated midwives or any other practitioners using these ideas in everyday practice. (If you want to read more about my research, you might like Post-term pregnancy: the problem of the boundaries or Stretching the fabric: from technocratic normal limits to holistic midwives’ negotiations of normalcy.)

Stretching the Fabric

As one of the article titles above implies, the concept of stretching the fabric was important to the midwives in this research. In fact, this phrase was used by one of the midwives. She said “I like to stretch the fabric of what is normal…” Several of these midwives described how they ‘widened the window’ to encompass a week or (more often) a month rather than a single date.

I always talk to them about having a due month, and, you know, if that is like the beginning to the end of a month or a whole, you know the middle of a month to the next. (Xena)

[I tell women] a lot that the date is not a set date, that it’s actually a whole month that the baby can be born in. If [the fixed point due date is] June 16th she should be ready between the 1st and the 30th of June, anytime. (Anna Andhra)

Sara Wickham’s bestselling book explains the process of induction of labour and shares information from research studies, debates and women’s, midwives’ and doctors’ experiences to help women and families become more informed and make the decision that is right for them.

What can we learn?

This is not unique. I am aware that a number of midwives like to mention the idea of a range, or at least note that the fixed point due date is not very reliable. The midwives in my research went quite a bit further than this, in three ways. And I think we can learn something from what they did.

1. Their discussions were ongoing. The proposing of a wider window is not something they did during the initial reckoning of the due date and then forgot about. The notion of the wider window is emphasised and discussed throughout pregnancy, which was considered as a journey. In other words, they offered continual reminders. I imagine that the women whose pregnancies were longer than average were less disappointed than they might otherwise have been as a result.

2. They explained their rationale. The midwives’ discussion of the wider window wasn’t some kind of secret incantation that was uttered in the hope that it would have some magical effect in reducing the risk of fixed point expectation syndrome. They were open and honest about it. They explained that they saw it as part of their role to help women move away from the absolute nature of the fixed point due date and towards a more flexible approach. The midwives’ rationale for doing this is linked to what they perceive to be the potentially stressful impact that a fixed due date can have on the woman, especially where this is perceived as an appointment (Davies 2003) which for many women will pass without any sign of labour.

3. They didn’t just talk to women. They understood only too well that pressure (often well intentioned and loving in nature) came from the woman’s family. So they took every opportunity to mention the fact that we need to think of this time as a window. Often, they described making half-joking, half-serious comments about it. (“Now don’t you [the woman’s partner] be booking time off work from that date onwards; it’ll just as likely come late in the due month as early [and] if the yard can’t be flexible about that, well you just tell them to call me [and] I’ll tell them.”)

In modern culture, it is not considered cool to be overdue – whether for a date, with a library book or when awaiting birth. And this can impact negatively on women. But maybe there are things that we can do about this, not just to help women to avoid fixed point expectation syndrome, but to help our whole society understand that seeking this level of certainty may not be a good idea.

References

Davies, R (2003). “I’m ready for you, baby, why won’t you come?” How long is a pregnancy and how long is too long? New Zealand College of Midwives Journal28(1): 8-10.

]]>“A womyn’s body is like a flower in nature. Some wimyn have had their petals forced open, physically or emotionally. Some wimyn have known the opening of their petals in ripe timing, according to their own desires. Either way, dreams help. They are from a mother’s own making, which in itself gives her great power and authority. We are like an invited guest to a mother’s dreamwork. With calm attention we become a witness to her truth telling. We can learn to ask helpful questions that lead her to an intimate relationship with her own power and intuitive knowing.

Demons are our fears. They visit us during moments of vulnerability and isolation. Within dreams they are like skeletons that come out of the closet at night and rattle at the foot of our bed, scaring the bejiggers out of us. Given the attention they demand, fears enhance self-awareness and wholeness. This transforming opportunity is greatly aided by the use of dreams as well as open dialogue or meditation or prayer.

During pregnancy, fears can serve a mother. They issue forth from her past experiences and her innate nature and alert her to danger. In this way, they are friends, not foes from whom the mother must fight or flee. They are part of her deep instinct. … Mastering the fear builds a bridge from ‘dis-ease’ to ‘self-ease.'”

]]>https://www.sarawickham.com/quotes-and-shares/dreams-help/feed/040697Fixed point due dates and wider windows (part 1)…https://www.sarawickham.com/articles-2/fixed-point-due-dates-and-wider-windows-part-1/
https://www.sarawickham.com/articles-2/fixed-point-due-dates-and-wider-windows-part-1/#commentsThu, 08 Aug 2019 05:30:16 +0000http://sarawickham.com/?p=831If Doctor Who turned up in front of you right now and offered you the chance to go elsewhere in time to change, remove or amend one tenet of modern maternity care, what would you choose? Even though I understand…

]]>If Doctor Who turned up in front of you right now and offered you the chance to go elsewhere in time to change, remove or amend one tenet of modern maternity care, what would you choose?

Even though I understand that the ripples would ripple out to affect other elements of the cosmos in unforeseen ways and all that, I know what I would pick. I would REALLY like to spend a day in an alternate universe which didn’t entertain the idea that it is useful to spend a couple of minutes at the beginning of pregnancy using a whirly wheel, app or other calculator to calculate an estimated date of birth which is then used as a reference point for the next two hundred and eighty or so days.

What’s the problem here?

The guesstimated due date calculation leads to grief and anguish for so many people. Having a fixed point due date can cause women to feel desperate as it looms and passes without the arrival of their baby. Fixed point due dates can lead to well-intentioned pressure from worried (and excited) families. And they lead to more intervention than some might consider necessary. Some women abandon all of their previous desires in the face of the pressure. That isn’t necessarily problematic in itself but I know from experience that a proportion of these women later regret not awaiting spontaneous labour.

All of this might be more justifiable if the setting of a fixed point due date were based on sound reasoning. However, as with so many aspects of maternity care, it is not built upon a solid foundation of evidence and can be challenged in many ways.

Fixed Point Expectation Syndrome

I use the term fixed point expectation syndrome to describe a human state that we can enter anytime we have been looking forward to something. Like, for example, the arrival of something exciting that one has ordered online. Or when we are waiting for news about whether we’re going to be offered an exciting new job. Consciously or subconsciously, we create a fixed point in our minds which represents the time and/or date on which we think the thing we are anticipating – in this case the arrival of the parcel or the news of the job decision – should occur. When it doesn’t arrive on time, we often experience negative feelings.

This is all a very natural and understandable human process, by the way, and no judgement or blame is intended. Estimated dates are seen as necessary if we are to organise our lives within the context of modern culture. No-one wants to take the whole week off to await their new patio furniture and, if no-one had a due date, midwives would find it much harder to organise their lives.

But it’s still an issue worth considering. The fixed point deadline we have created in our mind may or may not be a reasonable assessment of the likely timescale but, either way, there is a problem. The problem is called variability. The world we live in is uncertain and things vary. In a percentage of cases the estimated arrival date will be met or exceeded and the person will be happy. In other cases, the deadline will pass without the event having occurred. That’s normal. But many people don’t like it when they end up on what they see as the ‘wrong’ side of the normal range. The result of a fixed point expectation not being met can range from minor disappointment and the need to make an adjustment in planning your evening around the non-arrival of your new book or job offer to more major upset.

And when it’s a baby, not a book?!

Now magnify the excitingness of the parcel by a million, give a delivery estimate that is several months away and see how much fixed point expectation ensues. This is exactly what we do when we use a ‘due date’ to mark when we think birth might happen. No matter whether the woman herself or a health professional does the calculating, a percentage of women and their families are going to need to work really hard to adjust their thinking when the due date passes without even the first sign of a nesting urge.

Normality has a range.

Because pregnancy lasts for nine or ten months, the estimate can be out by two or three weeks for a good number of people. And, in a culture which promotes fixed point expectation syndrome, this has knock-on effects. In the worst-case scenario, it can lead to decisions which are out-of-sync with what the individual might have chosen in a less emotive and disappointed state. These are the kind of decisions that people may come to regret. This is why I would like to see what life – and birth – would be like in an alternate universe in which it had never occurred to anyone to calculate a fixed point due date.

Sara Wickham’s bestselling book explains the process of induction of labour and shares information from research studies, debates and women’s, midwives’ and doctors’ experiences to help women and families become more informed and make the decision that is right for them.

Yet I don’t think we have to give up hope.

What could we do?

I believe that there is one thing that we could all easily do that would make a huge difference, even in a universe that seems to almost revolve around fixed point due dates. We can accept that these are still going to be a reality and simultaneously embrace and share the notion of a wider window which offers a more realistic perception of when a baby will arrive. If we can help people to understand the degree of uncertainty involved in estimating such an event from such a long way off, and spread the idea that it is better to view this as a range rather than a fixed point, then I think we can help them not to experience fixed point expectation syndrome.

]]>The Cochrane collaboration first published a review on vitamin D in pregnancy in 2012. This was updated in 2016 and a 2019 update has just been published, which contains important changes deriving from the publication of new research studies. This updated review now includes the results of 30 trials which have involved 7033 women. The authors have looked at different combinations of supplements and compared these with a placebo or with no intervention, so the findings are complex, but here’s a helpful summary of the conclusions and changes from the Cochrane website:

“Supplementation with vitamin D alone (22 trials in total, 13 new trials added in this update) during pregnancy probably reduces the risk of pre‐eclampsia, gestational diabetes and low birthweight.

Supplementation with vitamin D + calcium (9 trials in total, three new trials added in this update) during pregnancy probably reduces the risk of pre‐eclampsia but may increase the risk of preterm births.

Supplementation with vitamin D + other nutrients (1 trial trial added in this update) in pregnancy may make little or no difference in the risk of preterm birth or low birthweight.

In general, more data are needed to conclude about the risk of maternal adverse events.” (Palacios et al 2019).

The authors of this study offer a clear and useful discussion of what kinds of research are needed in order to look into this further, and they also note that they are undertaking a related review of this topic. If you are involved in the care of pregnant women who may be offered vitamin D, I would highly recommend having a look at the review in more depth.

Readers of my Birth Information Update are always the first to find out about new studies … if you’d like a free monthly update delivered to your email inbox,click here to find out more and sign up.

]]>https://www.sarawickham.com/research-updates/vitamin-d-supplementation-in-pregnancy/feed/040766Love, kisses and other ways of knowing…https://www.sarawickham.com/articles-2/love-kisses-and-other-ways-of-knowing/
https://www.sarawickham.com/articles-2/love-kisses-and-other-ways-of-knowing/#respondThu, 01 Aug 2019 05:30:33 +0000http://www.sarawickham.com/?p=22241Sara Wickham asks whether maternity care providers and those who attend births are focusing on the right things.

]]>I once carried out a literature search on shoulder dystocia for a homebirth emergencies workshop and came across this fabulous quote by Sister Morningstar (2011). She takes rather different approach to most of the medically-focused papers that had come up in my search.

“The mother wants the baby out. The midwife wants the baby out and there’s a billion years of nature that want it all to work. Sometimes, beyond the intellect, beyond the textbook, beyond the steps one, two and three, there is a way. The way out of somewhere stuck and the Way in to peaceful freedom is what working with shoulder dystocia is all about.” (Morningstar 2011: 33).

Her article also included all manner of other useful information. She lists bullet points detailing predisposing factors, step-by-step assessment and thoughts about the resolution and evaluation of shoulder dystocia. Many of these were similar to those covered in the more mainstream articles and courses, though the language differes. But the sections that really struck me were those in which Sister Morningstar suggested that, after the baby is born, the midwife should, ‘stimulate the baby, cover with kisses, cover with a dry, warm blanket and assess for primary and/or secondary apnea’ (2011: 34). She also suggests that it is important to, ‘thank the mother for her strength, courage and cooperation’ (34). And then she concludes with the following words of wisdom:

‘Do not elicit fear in a mother, no matter what is going on. Elicit her conscious awareness and active participation. Her love for her baby has the most power and motivation to help’ (34).

How very, very awesome.

Does love even matter?

I’ve been on quite a few emergency skills study days and courses, mostly in the UK. None of them placed any importance on love, kisses or thanking women for birthing their babies. (Is it just me?) Neither can I find any reference to such things in the NICE guidance, and to my knowledge the only Cochrane review which mentions love is that evaluating early skin-to-skin contact for mothers and their healthy newborn infants (Moore et al 2007). That review looked at maternal affectionate love and touch during observed breastfeeding. But my experience, mostly helping women birth at home, is totally in accordance with the idea that love is an essential element at birth.

Love, it would seem, isn’t quite as all around us as Hollywood would have us believe. In fact, despite its importance, it’s often lacking in modern maternity care. I would wager that very few of the women who give birth today – with or without the need for extra attention to pushing their baby’s shoulders out – will be thanked for their courage and strength.

In fact, our culture has somehow managed to make women and their families think that it is they who should be thanking the professionals, who allegedly did all the work with mnemonics and manoevres. I don’t want to devalue midwives, doctors, doulas and other birth attendants, but it is women and babies and families who do the real work here. Love still gets most babies in, love can get babies out and, with the greatest respect to the scientific model, I suspect that love plays a greater part in making the world go round than our modern approach to life would have us imagine.